Case ReportAn Unusual Association: Iliopsoas Bursitis Related
toCalcium Pyrophosphate Crystal Arthritis
Marco Di Carlo,1 Antonella Draghessi,1 Marina Carotti,2 and
Fausto Salaffi1
1Rheumatology Department, Polytechnic University of the Marche,
Jesi, 60035 Ancona, Italy2Radiology Department, Polytechnic
University of the Marche, 60035 Ancona, Italy
Correspondence should be addressed to Marco Di Carlo;
[email protected]
Received 16 July 2015; Accepted 27 September 2015
Academic Editor: James V. Dunne
Copyright © 2015 Marco Di Carlo et al.This is an open access
article distributed under the Creative Commons Attribution
License,which permits unrestricted use, distribution, and
reproduction in any medium, provided the original work is properly
cited.
A 71-year-oldmanwith osteoarthritis and chondrocalcinosis came
to our observation developing a swelling in the groin region aftera
recent left colectomy for adenocarcinoma. The imaging techniques
revealed the presence of an iliopsoas bursitis in connectionwith
the hip. The synovial fluid analysis detected the presence of
calcium pyrophosphate (CPP) crystals and allowed the final
andunusual diagnosis of iliopsoas bursitis related to acute CPP
crystal hip arthritis.
1. Introduction
Hip pain sometimes could represent a challenge even forexpert
clinicians and could require many imaging techniquesefforts to
complete the differential diagnostic workup. Thehip is one of the
most complex joints of the human body,surrounded by a significant
number of ligaments and bursaethat complicate the detection of the
origin of a clinicalproblem. The iliopsoas bursa (also called
iliopectineal) isone of the largest articular recesses of the human
body[1]. It lies between the iliopsoas and pectineus
musclesanteriorly and the iliopectineal eminence and hip
capsuleposteriorly. While in the normal subject iliopsoas bursa isa
virtual cavity, in pathological conditions it could becomea
palpable mass. Usually a bursal enlargement is due toa hip joint
illness and communications between joint andbursa have been
described in the 15% of healthy subjects.The more frequent hip
diseases that could determine aniliopsoas bursitis are represented
by rheumatoid arthritis,osteoarthritis, osteonecrosis, synovial
chondromatosis, pig-mented villonodular synovitis, septic
arthritis, and com-plications of total hip arthroplasty [2–11].
Potentially, anycondition able to generate a joint effusion and
determining anelevation of intra-articular pressure may involve the
iliopsoasbursa, both in acute and in chronic damage. Between
theproinflammatory stimuli in order to cause a hip arthritis
are
included CPP crystals [12]. The inflammation of the bursaresults
in a disabling pain in the groin region, with the hipkept in
flexion and external rotation. Pain is enhanced bywalking or by any
action determining a joint extension. Bursacould be also painless
and revealed on clinical examination asa soft tissue mass. Other
manifestations of iliopsoas bursitiscould be secondary to the ab
extrinseco compression of thefemoral and iliac vessels (with
swelling of the thight or deepvein thrombosis of the leg), of the
femoral nerve or of thebladder [13–16].
2. Case Report
A 71-year-old Caucasian man, with a history of osteoarthritisand
knee chondrocalcinosis (Figure 1), never complicatedwith acute
arthritis, arrived to our department for a recentonset of pain at
right hip accompanied by homolateralswelling in the groin region.
Two months earlier, he under-went surgery (left colectomy) for
colic adenocarcinoma. Thepain arose rapidly within two weeks and
was determining asevere functional impotence of lower right limb.
The clinicalpicture was completed by the presence of a low-grade
fever(not higher than 37.2∘C).
The physical examination revealed the swelling area thatcould
easily be appreciated around and directly above the hip.The hip
range of the movement was extremely limited. The
Hindawi Publishing CorporationCase Reports in RheumatologyVolume
2015, Article ID 935835, 5
pageshttp://dx.doi.org/10.1155/2015/935835
Case Reports in Rheumatology 5
swelling in the groin region considered were a metastasis,a
lymphocele, a partially colliquative lymph node, or ahematoma.
Finally, the synovial fluid analysis avoided a new
surgicalintervention to resect the cyst, and the final diagnosis
wasestablished accordingly to the European League againstRheumatism
recommendations for calcium pyrophosphatedeposition [21].
In the evaluation of a patient with pain and/or swellingin the
hip region and with symptoms related to the lowerlimb difficult to
explain, the presence of an iliopsoas bursitisshould be kept in
mind.
Conflict of Interests
The authors declare that there is no conflict of
interestsregarding the publication of this paper.
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